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例1患者,女,50岁。因右眼睑下垂10年,双下肢无力8年,于1998年12月11日来诊。 1988年起右眼睑逐渐下垂,右眼裂变小,但无复视及疼痛;1990年出现双下肢无力,X线片胸腺不增大,故疑患重症肌无力(MG),中医行“强肌散”、“生力散”治疗半年,无力稍好转,但眼裂无变化。1995年曾行肌电图检查及低频重复刺激,3Hz、15％递增,5Hz、25％递增,单纤维电位检测正常;期间曾用新斯的明及吡啶斯的明均无效;临床观察,眼睑下垂,眼裂大小程度和休息、运动、早、晚均无密切关系;血糖检查有轻度糖尿病,行饮食控制。1998年12月因诊断不明,治疗无效,病情有所加重来诊。神经检查:右眼睑下垂、眼裂小,双眼各方向活动均受限,但无复视,双瞳孔等大同圆对光佳;Ach
Case 1 patient, female, 50 years old. Due to sagging of the right eye for 10 years and weakness of the lower limbs for 8 years, he came to the clinic on December 11, 1998. From 1988, the right eyelid gradually sagged, and the right eye was fissile, but there was no double vision and pain. In 1990, there was weakness of the lower limbs and the X-ray thymus was not enlarged. Therefore, myasthenia gravis (MG) was suspected, and the Chinese medicine firm “Strong Muscle” “Disperse” and “Shengli Powder” were treated for half a year, but their powerlessness improved slightly, but there was no change in the split eyes. EMG examination and low-frequency repeated stimulation were performed in 1995, 3Hz, 15% increase, 5Hz, 25% increase, single fiber potential detection was normal; during the previous use of neostigmine and pyridoxine were invalid; clinical observation, eyelid Sagging, the degree of eye fissure and rest, exercise, morning and evening are not closely related; blood glucose examination with mild diabetes, diet control. In December 1998, the diagnosis was unclear, the treatment was invalid, and the condition was worsened. Neurological examination: right eyelid drooping, small eye fissure, restricted movements in both directions, but no diplopia, double pupils, etc. Datong circle is good for light; Ach